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Hair loss overview

Hair loss (also known as alopecia) is a common problem, and can affect just your scalp or your entire body. Hair loss can occur in different patterns, depending on the cause. It can affect both men and women, and also children.

Hair loss can cause significant worry and anxiety, but there are several ways of treating and managing hair loss. Treatment depends on the type of hair loss.

How does hair grow?

The human scalp contains about 100,000 hair follicles. These anchor the hair to the skin and contain the cells that produce new hairs.

Hair grows in 3 phases.

The anagen or follicle growing phase starts growing the new hair. This phase is genetically determined and can vary from 2 to 6 years (the average is just under 3 years). Most hair follicles on the scalp are in the anagen phase.

The catagen phase is a transition stage between the growing and resting phases and lasts 1-2 weeks.

The telogen or resting phase is a mature hair with a root, which is held very loosely in the follicle. The telogen phase generally lasts about 4-5 months. About 100 telogen hairs are lost from the human scalp each day.

Different causes of hair loss affect the hair follicles in different phases of growth. See below for the different types of hair loss.

Tests and diagnosis

If hair loss is worrying you in any way, see your doctor.

Also see your doctor if:

you are experiencing hair loss and you are feeling unwell;

your hair loss involves hair from the scalp plus other parts of your body; or

you have hair loss that is accompanied by changes in the appearance of the underlying skin.

Your doctor will ask about your hair loss, and about your health in general. They will also perform a physical examination, including looking at your scalp and any other affected areas to determine the pattern of hair loss.

Tests may be needed if your doctor suspects that your hair loss is due to a cause other than age-related hair loss. Referral to a skin specialist (dermatologist) for a hair and/or skin biopsy may be suggested. In addition, a thorough check of your overall health (including tests such as blood tests) may be recommended to find out if you have any underlying medical problems related to the hair loss that may need treatment.

Types of hair loss and treatments

There are several reasons for hair loss, including inherited conditions, medical problems, hormonal changes and reactions to certain treatments.

Depending on the cause for the hair loss, it may:

affect just your scalp or the scalp and other areas of your body (e.g. eyebrows);

progress quickly or slowly; and

be permanent or temporary.

There are also varying degrees of hair loss, ranging from mild to excessive. Excessive hair loss from the scalp can be called baldness.

You may decide, depending on the cause and degree of hair loss and how much it bothers you, to simply let the hair loss run its course. However, if you are unhappy with the impact the hair loss has on your appearance, there are treatments available.

Treatment may be aimed at:

stimulating hair regrowth;

slowing down the loss of hair; or

disguising hair loss.

Your doctor will be able to advise you on the most suitable option for you, depending on the cause of your hair loss and how extensive the hair loss is.

Androgenetic alopecia

Androgenetic alopecia is a genetic condition that can affect both men and women as they age. It is the most common cause of hair loss, affecting about 50 per cent of all men by the age of 50 years.

In men, androgenetic alopecia is also referred to as male pattern hair loss or inherited male pattern baldness. The hair loss occurs in a distinct pattern - usually the hair loss begins at the temples, progressing to the forehead with a receding hair line, then a bald patch may develop at the back or crown of the head. Ultimately, all hair can be lost from the top of the head.

Androgenetic alopecia in women is known as female pattern hair loss. It generally results in thinning of the hair over the top of head, sometimes with a widening of the hair part line. There may be episodes of excessive hair shedding.

The hair follicles on the scalp in people with androgenetic alopecia are extra-sensitive to circulating male hormones (androgens). This inherited sensitivity causes the hair follicles to produce progressively shorter, finer hairs as you get older. The age when hair loss starts and how much hair is lost tends to run in families. It is possible for this type of hair loss to start as early as puberty.

Treatment

There are treatments available to help prevent or slow down further hair loss and also promote hair regrowth in androgenetic alopecia.

In men with male pattern hair loss, there are treatments that you apply directly (topical) to the scalp (minoxidil solution) and tablets (finasteride) that can be taken. In some men, both treatments can be taken together.

Women with female pattern hair loss can also try topical and oral medicines to help stop hair loss and stimulate new hair growth. Topical minoxidil (solution that you apply to the scalp), spironolactone or cyproterone tablets (anti-androgen medicines), or a combination of both may be recommended.

It can take 6-12 months before any noticeable effect is seen with these treatments, and there are side effects associated with the medications. Also, the effect is only maintained while you continue to take the treatment. Talk to your doctor about risks versus benefits of treatment.

Many people are not bothered by the effect that age-related hair loss has on their appearance - in these cases no treatment is needed.

Alopecia areata

Alopecia areata is an immune system disorder in which scalp hair falls out in uneven, round patches. Body hair (such as eyebrows and eyelashes) may also be lost. It sometimes results in total baldness.

Alopecia areata is due to inflammation of the hair bulbs. It tends to affect people in their teens and 20s, and is more common in people who have a family history of the condition.

People with alopecia areata may also have roughened fingernails.

Treatment

Treatment will depend on how much hair has been lost and how long you have had the condition. The hair may regrow on its own after a few months, or treatment may be needed to encourage regrowth.

If you have a small patch of hair loss that has recently appeared, your doctor may recommend applying a steroid cream to your scalp for several months.

If this treatment is not helpful, or if the hair loss involves a larger area, your doctor may refer you to a specialist for further treatments, such as injections of corticosteroids into the affected areas, minoxidil, immunotherapy or immunosuppressants.

Telogen effluvium

Telogen effluvium is a form of temporary hair loss that may follow an event or illness, such as:

childbirth or pregnancy;

major surgery;

severe stress or sudden shock, such as a bereavement;

severe illness accompanied by a high fever;

long-term illness;

rapid weight loss;

severe nutritional deficiency; or

thyroid disease.

In these cases, the illness or event triggers hairs on the scalp to change from the anagen phase to the telogen phase, resulting in excessive hair loss.

While the hair thins, sometimes coming out in clumps, telogen effluvium does not result in baldness. Hair loss usually stops within about 6 months and regrowth should occur naturally. In some cases the hair loss lasts longer.

Treatment

If you have a known trigger for hair loss, it should be avoided if possible. If medicines are thought to be the cause, you may need to change medications, but remember to always check with your doctor before stopping or changing your medicines.

Sometimes treatment with medicine such as topical minoxidil (solution that you apply to the scalp) is recommended to speed up hair regrowth.

Anagen effluvium

Widespread hair loss from the scalp and body is known as anagen effluvium. Common causes include:

chemotherapy used to treat cancer; and

radiation or immunotherapy treatment for cancer.

In most cases, once the treatment has been stopped the hair regrows.

Bear in mind that not all types of chemotherapy cause hair loss, and sometimes hair loss associated with chemotherapy is only mild.

Scarring alopecia

Scarring alopecia is a condition in which various processes (e.g. burns or skin conditions) can permanently destroy hair follicles through scarring. Early treatment can help in some cases where there is inflammation of the scalp, but in many cases of scalp alopecia hair re-growth is not possible.

If your doctor suspects you have a type of scarring alopecia, they will most likely refer you to a specialist for treatment.

Trichotillomania

Trichotillomania is a condition of compulsive hair picking or pulling that can lead to patches of near complete hair loss. The areas most often affected are the front and side of the scalp.

In children, trichotillomania is usually just a habit and parents can help stop their child from hair pulling and plucking. In adults (and some children) the condition may be related to other psychological issues, and seeing a psychologist or psychiatrist may be recommended.

Infections

Fungal infections (e.g. ringworm, also known as tinea capitis when it affects the scalp) can cause patchy hair loss. This is more common in young children and rarely affects adults.

The scalp is also usually scaly or crusty as a result of the fungal infection.

Hair usually grows back once the fungal infection has been treated with antifungal medicines.

Cosmetic and surgical treatments for hair loss

If specific treatments have not helped and you are not happy with your appearance due to the hair loss, there are several options available. These include:

wearing a wig or toupee;

colouring the scalp with a camouflage dye or tattoo;

using hair thickening fibres;

hair transplant surgery;

artificial hair fibre implantation; and

scalp reduction surgery.

Talk to your doctor about these options before deciding which, if any, may be suitable for you.

Unproven treatments

There are many treatments suggested for hair loss which have not been shown to be effective. These include jojoba oil, lanolin, wheatgerm oil, nutritional supplements, scalp massage, laser and acupuncture. Again, speak to your doctor before opting for these or any other hair loss treatment options to avoid unwanted effects and spending time or money on a treatment that is unlikely to help.

Support

There are support groups in Australia for people with various conditions involving hair loss. Information and support from other people living with conditions such as alopecia areata can be invaluable. Talk to your doctor about support groups for your type of hair loss.

When should you seek medical advice?

You should seek medical advice for hair loss if:

you have recently started a new medicine;

you are a woman and your hair loss is accompanied by excess growth of facial and body hair or you have acne;

you have been diagnosed with (or think you may have) an autoimmune disorder such as systemic lupus erythematosis (SLE), nutritional deficiency or thyroid disease;

you have been recently treated with chemotherapy or have used a hormonal medicine;

the hair loss occurs in discrete patches;

the hair loss is associated with scaling or inflammation of the scalp;

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